Background:

Treatment adherence plays a significant role in the successful management of rheumatic disease. Adherence itself may be influenced by patient-physician relationship factors and a patient's overall physician trust.

Purpose:

We investigated whether specific components of the patient-physician relationship were directly associated with the more global concept of physician trust; we then assessed the extent to which these relationship components influenced treatment adherence via their impact on overall physician trust.

Methods:

We performed a cross-sectional study of outpatient clinic patients with rheumatic disease, i.e., Rheumatoid Arthritis (RA) or Systemic Lupus Erythematosus (SLE). Six specific components of the patient-physician relationship were measured: doctor informativeness, sensibility to concerns, reassurance and support, patient centeredness, participatory decision-making, and patient disclosure of information. Patient's physician trust was evaluated using the Wake Forest Physician Trust Scale, while treatment adherence was measured via the Compliance Questionnaire Rheumatology (CQR). A conceptual model was developed, with the relationship component variables predicting trust, and trust predicting adherence. We statistically assessed bivariate relationships across all model variables, using Pearson product-moment correlations. We then conducted a path analysis to test our conceptual model and identify statistically significant direct, indirect, and total effects of the conceptual model's patient-physician relationship variables on physician trust and treatment adherence. Path analysis' particular strength lies in its capacity to model and then simultaneously estimate a number of regression equations when exploring complex relationships. For the path analysis we analyzed the model variable covariance structure.

Results:

Our sample included 311 patients (201 with RA and 110 with SLE). Eighty percent of patients were female; mean patient age was 46 years. Bivariate correlations were all positive and statistically significant (p<0.05) and ranged from 0.250.79. In the path analysis, 4 of 6 relationship component variables (doctor informativeness, reassurance and support, patient centeredness and participatory decision-making) were found to have statistically significant direct effects on trust and indirect effects on treatment adherence; trust had a statistically significant direct effect on adherence. The overall path analytic model displayed good fit to the data (chi-square=2.56, p=0.63, RMSEA<0.01).

Conclusion:

Patients' perceptions of multiple specific components of their relationship with their physician are associated with patient trust in their physician, which is strongly related to treatment adherence, with greater trust enhancing adherence. Modifications to specific components of the patient-physician relationship, namely doctor informativeness, reassurance and support, patient centeredness and participatory decision-making, could potentially improve treatment adherence by increasing physician trust.